INSTRUMENTS Veterinary Surgical Nursing Surgical Instruments INSTRUMENTS Relevant

INSTRUMENTS Veterinary Surgical Nursing Surgical Instruments

INSTRUMENTS Relevant Learning Outcomes Commonly used instruments 1. Identify 2. Describe usage 3. Maintain

INSTRUMENTS What’s in a name? - Mayo • Mayo Family- American doctors of early 1900’s • founded renowned Mayo Clinic in Rochester, Minnesota, USA. • Today 500+ doctors at this clinic

Metals INSTRUMENTS • Surgical Stainless steel – Ideal metal for most instruments • Tungsten carbide – Used for inserts where strength and durability important • Chrome plated carbon steel – Cheap, but blisters and corrodes easily

Needle Holder e. g. Mayo. Hegar INSTRUMENTS Tips Jaws Box lock Shank Ratchet Ring handle

INSTRUMENTS Needle Holder Functions • Hold needle • Tie knots

INSTRUMENTS Needle Holder Features Optionally – Scissors • For cutting sutures • But can accidentally cut suture! – Ratchet • For more secure grip • But can get ratchet caught in gloves

INSTRUMENTS Needle Holder Types • 4 types Gillies Olsen-Hegar Mayo-Hegar Mathieu/Mc. Phails

INSTRUMENTS Needle Holder Types • 2 kinds of Hegars – not Hägars! Olsen Mayo

Needle Holders INSTRUMENTS • What does your practice have? • What would you prefer?

Scissor Uses • • Heavy dissection Fine dissection Sutures Bandages INSTRUMENTS

Scissor Features • Blades – Straight – Curved • Tips – Round only (=Blunt) – Sharp only – Combination of Round & Sharp • Edges – Plain – Serrated INSTRUMENTS

Scissor Types • • INSTRUMENTS Heavy dissection (Mayo) Fine dissection (Metzenbaum) Suture removal Dressing

Mayo Heavy dissection INSTRUMENTS

Metzenbaum Fine dissection INSTRUMENTS

Suture removal Sharp. Blunt INSTRUMENTS Notched

Dressing scissors INSTRUMENTS

Forceps • • Thumb (tweezers) Tissue Haemostatic Intestinal clamps Bone holding Sponge-holding Syringe-holding INSTRUMENTS

INSTRUMENTS Thumb Forceps (tweezers) • Plain – Delicate tissues (e. g. viscera) – Dressings • Toothed – Skin & Connective tissue • • Single row of teeth (dissection) Pad of teeth (wound closure) Long Mesh of teeth (holding vessels) Curved row of teeth (holding needles)

INSTRUMENTS Thumb Forceps – Plain Dressing

INSTRUMENTS Thumb Forceps – Rat-tooth Rats Teeth?

INSTRUMENTS Thumb Forceps – Tooth Pad of teeth (Brown. Adson) Rat tooth heavy Rat tooth fine (Adson) Long Mesh of teeth (De. Bakey)

INSTRUMENTS Thumb Forceps – Tooth Russian

Tissue Forceps Have Ratchet grips INSTRUMENTS

Tissue Forceps 2 kinds – Toothed type (Allis) – Bar type (Babcock) INSTRUMENTS

Tissue Forceps Allis Babcock INSTRUMENTS

Tissue Forceps Always cause some trauma – But OK on tough tissues (fascia) INSTRUMENTS

INSTRUMENTS Haemostatic Forceps • Used to compress blood vessels • If curved – point curved tips up to pass ligatures

INSTRUMENTS Haemostatic Forceps • Transverse grooves – Small (Mosquito) – Large (Crile, Kelly, Rochester-Pean) – Plus rats teeth (Rochester-Ochsner) • Longitudinal grooves – Large (Rochester-Carmalt) • Less likely to slip on large bundles • Recommended for ovarian pedicles (spays)

INSTRUMENTS Haemostatic Forceps Mosquito – small

INSTRUMENTS Haemostatic Forceps Crile – Fully grooved jaws

INSTRUMENTS Haemostatic Forceps Kelly – Partly grooved jaws

INSTRUMENTS Haemostatic Forceps Rochester-Carmalt – Longitudinally grooved – For strong but soft grip on large pedicles (spays)

INSTRUMENTS Haemostatic Forceps Angiotribe – Longitudinally slotted – For strong grip on large pedicles (large animals)

INSTRUMENTS Haemostatic Forceps Rochester-Ochsner – Extra grip on tips

Intestinal forceps Doyen clamps – Used to stop leaks from cut ends of intestines – Not as good as an assistants fingers ! INSTRUMENTS

INSTRUMENTS Sponge-Holding Forceps • i. e. swab forceps

INSTRUMENTS Syringe-Holding Forceps

Towel Clips 2 mechanisms – Ratchet • Backhaus • Roeder – Cross-action spring • Grays • Schaedel INSTRUMENTS

Towel Clamps Ratchet (Roeder) Ratchet (Backhaus) INSTRUMENTS Cross-action (Grays)

Scalpels • Small animal – Flat handle #3 – Blades 10, 11, 15 • Large animal – Flat handle #4 – Blades 20, 21 • Eye surgery – Round handle (Beaver) INSTRUMENTS

INSTRUMENTS Scalpels – Many Types 10 11 15 21 20

INSTRUMENTS Scalpels – Commonly Used Large Animal Small Animal

Scalpel Handles • Large flat handle – Bard-Parker #4 • Small flat handle – Bard-Parker #3 • Round handle – “Beaver” INSTRUMENTS

Retractors • Hand held – – – Senn Army-navy Volkmann Malleable Hohmann • Self retaining – – – Gelpi Weitlaner Balfour Gossett Finochietto INSTRUMENTS

INSTRUMENTS Hand held Retractors Senn

INSTRUMENTS Hand held Retractors Army-Navy

INSTRUMENTS Hand held Retractors Volkmann

INSTRUMENTS Hand held Retractors Malleable – bend to shape

INSTRUMENTS Hand held Retractors Hohmann – Orthopaedics (cruciates, hips) – Also known as “bone levers”

INSTRUMENTS Self retaining Retractors Gelpi – muscle & joint (i. e. orthopaedics)

INSTRUMENTS Self retaining Retractors Weitlaner – fascial

INSTRUMENTS Self retaining Retractors Balfour – abdominal

INSTRUMENTS Self retaining Retractors Gossett – abdominal

INSTRUMENTS Self retaining Retractors Finochietto – Chest

INSTRUMENTS Periosteal Elevators • Used to strip soft tissue (i. e. periosteum) from bone • Handles – many variations • Working ends – a rounded side – a flatter side with a sharp edge

INSTRUMENTS Periosteal Elevators

Bone Curettes INSTRUMENTS • Used to scrape (debride) tissue – Infected bone – Infected tooth sockets

Bone Curettes Examples INSTRUMENTS

INSTRUMENTS Bone Cutting Instruments • • • Bone Shears Bone Chisels & Osteotomes Bone Saws Wire (Gigli) Trephines Rongeurs

Bone shears INSTRUMENTS

INSTRUMENTS Osteotome or Chisel?

INSTRUMENTS Osteotome & Chisel osteotome chisel

INSTRUMENTS Guarded osteotome

Rongeurs INSTRUMENTS • Used to “nibble away” bone or cartilage • Various “actions” – 1 hinge > Single action rongeurs – multiple hinges > Double action rongeurs • Double action provide greater leverage

Rongeurs INSTRUMENTS Examples single action double action

Bone Graft Collection • Methods – Osteotome – Curette – Rongeurs INSTRUMENTS

Orthopaedic mallet INSTRUMENTS

INSTRUMENTS Bone holders – Kern

INSTRUMENTS Bone holders – Kern

INSTRUMENTS Bone holders – Reduction Forceps • These are not towel clamps!

INSTRUMENTS Bone holders – Reduction Forceps

INSTRUMENTS Bone holders – Verbrugge • Bone to plate holders

INSTRUMENTS Bone holders – Lowman

Drilling 1. 2. 3. 4. Air drill Electric drill Hand drill Jacobs chuck INSTRUMENTS

Air Drill • Autoclavable INSTRUMENTS

Electric Drill • Not autoclavable – Requires protective sheath INSTRUMENTS

Hand Drill • Autoclavable INSTRUMENTS

Jacobs Chuck • Autoclavable • For inserting Pins INSTRUMENTS

Wire instruments • Wire passers • Wire twisters • Wire cutters INSTRUMENTS

Wire passers INSTRUMENTS

Wire twisters INSTRUMENTS • These look like needle holders – But shouldn’t use needle holders for wiretwisting!

Wire cutters INSTRUMENTS

Probes Grooved probe for anal sac removal INSTRUMENTS

Spay Hooks • 2 different tips (flat or knob) INSTRUMENTS

Trephines • Bone biopsies • Bone tunnels INSTRUMENTS

Orthopaedic Wire INSTRUMENTS • Cerclage wire – Various gauges – Supplied on spools – 22, 20 and 18 gauges commonly used • Cutting (Gigli wire)

Bone Pins • Large pins > “Steinmann pins” – ¼ to 1/16 inch – Trocar points only – Also called Intramedullary Pins • Small pins > “K wires” & “Arthrodesis wires” – 0. 9 -2. 0 mm – Trocar or Chisel points – Often used as Crossed Pins or ‘Pin & Tension Band’ • External fixator pins INSTRUMENTS

Steinmann Pins INSTRUMENTS • Placed inside bone marrow cavities for fracture repair

INSTRUMENTS Measuring diameters Pins K-wire Drill bits Screws

External fixator • Pins • Rods • Clamps INSTRUMENTS

Bone Screws INSTRUMENTS • Thread type – Cortical – Cancellous • Thread extent – Full length thread – Partial length thread • Thread Raised above smooth shaft (+ profile) • Thread Cut out into smooth shaft (- profile)

Bone Screws • Diameters (mm) – 1. 5 – 2. 0 – 2. 7 – 3. 5 – 4. 5 – 5. 5 – 6. 5 small animals large animals INSTRUMENTS

Bone Screws • Thread extent – Full length thread – Partial length thread • Heads – Hex – Cross INSTRUMENTS

Kick Bucket • Try not to kick it too soon ! INSTRUMENTS

INSTRUMENTS The End

INSTRUMENTS